Compulsory methadone maintenance treatment of severe cases of drug addiction in a residential setting in Tehran, Iran (1): Process evaluation

An urgent project for arresting and mandatory treatment of high risk drug addicts started in May 2007 in Tehran. After triage, those with more severe patterns were sent to a residential center for compulsory methadone maintenance treatment. This paper presents the evaluation of the process of interventions. The two and six-months follow-up outcomes are presented in the second paper. Seventy nine drug addicts that were arrested within 11 days and sent to Shafagh residential center were followed. Repeated individual interviews with the residents, focus group discussions, morphine test in urine, observations, reviews of the records and reports, interviews with staff and authorities of involved organizations were conducted. The majority of the drug addicts welcome methadone maintenance treatment. During residence, morphine test was positive in 20% and 4% in the first and second time of assessment, respectively. From the 79 individuals entering the residential center, three fourth were kept less than 50 days. There were shortcomings in providing services. During the first months, the strict control of the police, was impairing the supported environment needed for treatment. However, the majority of residents were satisfied with the provided compulsory treatment. Cooperaion of law enforcement and Ministry of Health, preparation of treatment protocol, and evaluation were strengths of the whole project, which differentiated it from previous similar efforts. It is suggested that the project be continued as an experimental field without expansion in order to integrate judiciary supervision, improving the process and utilization of a variety of approaches.